Prospective Study Examining Clinical Outcomes Associated with a Negative Pressure Wound Therapy System and Barker’s Vacuum Packing Technique

Abstract

BackgroundThe open abdomen has become a common procedure in the management of complex abdominal problems and has improved patient survival. The method of temporary abdominal closure (TAC) may play a role in patient outcome.MethodsA prospective, observational, open-label study was performed to evaluate two TAC techniques in surgical and trauma patients requiring open abdomen management: Barker’s vacuum-packing technique (BVPT) and the ABTheraTM open abdomen negative pressure therapy system (NPWT). Study endpoints were days to and rate of 30-day primary fascial closure (PFC) and 30-day all-cause mortality.ResultsAltogether, 280 patients were enrolled from 20 study sites. Among them, 168 patients underwent at least 48 hours of consistent TAC therapy (111 NPWT, 57 BVPT). The two study groups were well matched demographically. Median days to PFC were 9 days for NPWT versus 12 days for BVPT (p = 0.12). The 30-day PFC rate was 69 % for NPWT and 51 % for BVPT (p = 0.03). The 30-day all-cause mortality was 14 % for NPWT and 30 % for BVPT (p = 0.01). Multivariate logistic regression analysis identified that patients treated with NPWT were significantly more likely to survive than the BVPT patients [odds ratio 3.17 (95 % confidence interval 1.22–8.26); p = 0.02] after controlling for age, severity of illness, and cumulative fluid administration.ConclusionsActive NPWT is associated with significantly higher 30-day PFC rates and lower 30-day all-cause mortality among patients who require an open abdomen for at least 48 h during treatment for critical illness.

Update from the Abdominal Compartment Society (WSACS) on intra-abdominal hypertension and abdominal compartment syndrome: past, present, and future beyond Banff 2017

“…The coincident evolution in resuscitation with hemostatic or balanced blood component resuscitation strategies [11][12][13][14] that limit use of crystalloid fluids are most probably also highly associated with a reduction in the prevalence of ACS (recognizing that excess crystalloid fluids are likely to be central in many cases of IAH/ACS) [15,16]. In support of these practices, a reduced incidence of open abdomens and ACS [17], and higher rates of abdominal closure with the adoption of damage control resuscitation and the use of negative pressure peritoneal therapy have been noted [18][19][20]. In 2017, the incidence of overt ACS is significantly lower than previous decades and may even been rare in some institutions.…”

“…It is now possible that we may wish to have an open abdomen in the sickest septic patient not because we have to, but because we want to. It is now theorized that having an open abdomen to allow for greater peritoneal drainage in intra-abdominal sepsis may fundamentally ameliorate the course of systematic sepsis [19,20,40,41]. In this context, the emerging role of the microbiome in critical illness, and how it is affected by changes within the abdominal compartment, is a dimension that has been ignored for many years and requires our urgent attention.…”

Manejo Del Abdomen Abierto: Desde La Operación Inicial Al Cierre Definitivo

“…Las TPN han marcado un importante punto de inflexión, significando el mayor avance en las técnicas de cierre parietal temporal 103,104,18,[109][110][111]114,146,157 . El método consiste en colocar una lámina no adherente multifenestrada cubriendo las vísceras abdominales, extendiéndola lateralmente hasta las goteras parietocólicas, hacia arriba hasta los espacios subfrénicos y hacia abajo hasta la pelvis menor.…”

How to deal with an open abdomen?

“…Cheatham et al [33] found in a prospective open-label study that NPT compared to the Barker vacuum-pack technique was associated with increased primary fascial closure rates in patients who required OAT for at least 48h. They also reported lower mortality rates in patients treated with NPT after controlling for several variables.…”

“…Cheatham et al [50], in a prospective observational study, demonstrated the effectiveness of negative pressure therapy in the open abdomen. Not only were closure rates higher by 2.8 times, but the overall effect was to lower mortality in this complex group by a factor of 4.…”